406215575-6-21-2022-17-CC-FPEA-CFLTAT-20220621143404

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 406215575
Report Date: 06/21/2022
Date Signed: 06/21/2022 02:34:11 PM

Document Has Been Signed on 06/21/2022 02:34 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME:	COLES FCC AKA ADVENTURE DAY CAMP		FACILITY NUMBER:	406215575
ADMINISTRATOR:	KIMBERLY MAE COLES		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(805) 610-4961
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY:	14	CENSUS: 13	DATE:	06/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:32 PM
MET WITH:	KIMBERLY COLES		TIME COMPLETED:	02:48 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On June 21, 2022 at 12:35 PM, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Annual/Random inspection. LPA with Licensee Kimberly Coles and advised her the purpose of the inspection. Licensee provided LPA a tour of the home inside and out. There were 13 children in care and two (2) assistants at the time of the inspection. Licensee has a single story home. Licensee uses the living room, kitchen, one (1) bedroom, one (1) bathroom, and the backyard for children in care. The rest of the home is off-limits to children in care. A current 2A10BC fire extinguisher was observed mounted on the wall in the laundry room. LPA reminded licensee that the fire extinguisher must be serviced or a new one purchased annually. LPA did not observe hazards/toxins accessible to children in care. Licensee stores the disinfectants/chemicals under the sink and in the laundry room. LPA observed age appropriate toys, books, activities and furniture readily accessible for children in care. The backyard is enclosed with a fence. Licensee has a large back yard with age appropriate toys, basketball court, drained wading pools, and play structures readily accessible for children in care when they are outside playing. LPA observed a trampoline properly secured with a safety net. Licensee advised the trampoline is for personal use only and that it is off-limits to children in care. Licensee advised they do not have firearms or live ammunition in the home. LPA reviewed a sampling of children and staff records. The children and staff records were found to be current and complete. Facility staff met the requirements for Mandated Reporter and CPR/First-Aid. LPA spoke with licensee about current Covid-19 requirements. Licensee is following current guidelines. Licensee was provided a Carbon monoxide resource. No deficiencies were cited during today's inspection. Continued on 809-C

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: COLES FCC AKA ADVENTURE DAY CAMP	FACILITY NUMBER: 406215575
	VISIT DATE: 06/21/2022

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Home Section 102417. When any IMS is provided, a plan for providing IMS must be submitted to the Department. The following information regarding ADA was provided. US Department of Justice (USDOJ) toll-free ADA information line at (800) 514-0301 (voice) / (800) 514-0383 (TTY) and link to publication: Commonly asked questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee

SUPERVISOR'S NAME: Maria Mueller	TELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-6267
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022

LIC809 (FAS) - (06/04)

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